It is generally accepted that early and specialized pre-hospital
patient treatment improves outcome in terms of mortality and morbidity,
in emergency cases. The focus of this paper is to present the
implementation and the evaluation of an ambulance located telemedicine
system for pre-hospital patient treatment. The primary emphasis is on
the vital sign transmission from the accident site or the moving
ambulance to the consultation site, using the GSM mobile telephony
network. There, the experts evaluate the patient data, decides about the
treatment protocol and provide directions to the ambulance’s medical
staff concerning on the patient handling until the arrival to the
hospital.
A. Project Design and Equipment. Emergency units such as ambulances,
patrol cars and firevehicles are participating in this project. The
operations are controlled by a small-scale trauma dispatch center,
located in the University Hospital of Rion, Greece. All units are
equipped with Global Positioning System (GPS) devices [14], able to
transmit, via GPRS modems, the vehicle’s current position to the
dispatch center, for vehicle control and management. A “clever
mechanism”, installed both on vehicles and on controller in traffic
intersections, forces in an indirect manner the transition to a “green
light” when the ambulance is in a direction towards the corresponding
traffic lights and in an adjustable radius. This capability makes
possible the road to be free of traffic in the moving direction of
vehicle. Additionally, each ambulance is equipped with: •special medical
devices to acquire vital signs, such as electrocardiogram (ECG), Blood
Oxygen Saturation (SPO2), Non Invasive Blood Pressure (NiBP),
Temperature (Temp), from patients and transmit them to the dispatch
center using the GSMnetwork [13] – [16]. The data can be collected on
the field of accident or en route to the hospital (Fig. 1), •a wireless
LAN (IEEE 802.11) to transmit patient video or still images acquired by a
wireless camera, from the ambulances to the dispatch center. In the
trauma dispatch center is installed: •a Geographic Information System
(GIS) [14] based street network data set, which is managed by a
computer. The GIS operator can observe the exactly location and movement
characteristics of all vehicles, •a server hosting still images or
video transmittedfrom the ambulances’ wireless cameras, •a server
hosting vital signs transmitted from the ambulances. B. Telemedicine
equipment and transmission. The core of the telemedicine system is a
portable device collecting and transmitting vital signs. Within this
project, a market analysis has been performed evaluating diverse market
available vital signs devices constructed by various manufacturers. The
final decision has been based in the following specifications and
restrictions: •fit to the small free space inside the ambulance, •light
and portable, •a compact construction tolerant both to the bad
mechanical and electromagnetic conditions, •waterproof, dustproof, oil
proof, •built in transmission capability, easy connection to the
patients body for vital sign collection, •user friendly, •communication
over the GSM network, which has significant coverage in Greece, •secure
data transmission, •no independent devices for each vital sign butmany
devices integrated into a common package. Independent devices take up a
lot of space, and need a lot of probes and cables for their installation
and operation. Also, the operators need to spend alot of time to
connect them to the patients. The other investigated category was the
medical monitors. A medical monitor includes the measurement of many
vital signs in a small cased device. But the usage onextreme conditions
feeds the measured signal with artifacts, garbling the data. The result
of the above market analysis led us to employ of a defibrillator device
equipped with embedded vital signs amplifiers. This device allows the
ambulance staff to: •measure and transmit of vital signs during the
patient collection and transportation to the first aid center, and
•defibrillate the patient if it needs so (after the experts advice),
•carry the equipment in an accident area away fromthe ambulance. The
selected defibrillator device handles the following vital signs: •Up to
12 lead ECG, •Blood Oxygen Saturation (SpO2), •Heart Rate (HR),
•Non-Invasive Blood Pressure, •Temperature, •Invasive Blood Pressure
(IP), •CO2 measurement. Code Shoppy
The implementation of the other part of the telemedicine system, the
dispatch center, has been organized on the basis of the following
specifications and restrictions: •Demonstration and modification of the
patient demographic data, •Preview and measurements of the received
medical data, •Archiving capabilities, •Capabilities for
computer-assisted diagnosis, •Signaling of any new incoming incident,
•Secure data reception and verification, •User friendly interface. The
software running on any workstation of the dispatch center has to
include a restricted number of different working windows (forms)
demanding the minimal possible users actions. Figure 2,3 and 4 depict
some working windows of the dispatch center. In Figure 2, the expert can
see all events, alarms, the chronological list of the collected data,
curvesrepresenting continuously recorded parameters, values in each
point etc. In Figure 3, up to 12 lead electrocardiogram strips collected
from the patient can be observed. Figure 4 shows the tools provided to
the doctor in order to perform measurements on the ECG strips.
The aforementioned system was designed and implemented in order to
assure that an emergency case will be served on the minimum time. So, if
the vital sign collection and transmission starts being performed by
the paramedics the time needed for in hospital evaluation
willsignificantly decrease. Also, it is possible that the patient’s
therapy begins during his transportation depending on patient’s health
emergency level and the expert’s direction.
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